Anal fistulas are common among those who have had an anal abscess. It develops between the skin and the muscular opening, anus, at the end of the digestive tract. Most of the fistulas occur as a result of the infection that starts in the anal gland which further causes an abscess. An anal fistula usually needs surgery for its treatment.
These are types of fistulas depending on their location that include:
- Intersphincteric fistula: It is the most common type of anal fistula which is an abnormal tract found near the anus or rectum. It is found between the internal and external sphincter muscles and ends close to the anus.
- Trans-sphincteric fistula: The tract begins in the space between the internal and external sphincter muscles or in the space behind the anus and opens slightly outside the anal opening. It is also known as horseshoe fistula.
- Suprasphincteric fistula: It turns upwards to a point above the puborectal muscle and opens outside the anus.
- Extrasphincteric fistula: This is caused by either Crohn’s disease or abscess. It begins at the rectum and extends downwards opening around the anus.
Causes of anal fistula
There are various glands that produce fluids which sometimes get clogged. This builds up a lump of infected tissues and the fluid which is known as an abscess. Other causes of anal fistula include:
- Crohn’s disease which is an inflammatory disease of the intestine
- Sexually transmitted diseases
- A condition called diverticulitis in which small pouches are formed in the large intestine and become inflamed
- Some ongoing problem that affects bowel
Symptoms of anal fistula
The symptoms of the anal fistula include:
- Frequent anal abscess
- Pain and swelling around the anus
- Foul smelly discharge from an opening around the anus. As the fistula drains, the pain may reduce
- Irritation on the skin around the anus from drainage
- Pain with bowel movements
- Pain while sitting
- Fever and chills and feeling of fatigue
How is anal fistula diagnosed?
Some fistulas can be spotted easily and some heal on their own. The doctor usually diagnoses anal fistula by examining the area around the anus. The doctor looks for the opening on the skin and oozing fluid. The doctor may put the finger into the anus during diagnosis. He may ask you to get imaging tests such as X-rays or CT scan or even colonoscopy. Colonoscopy is the process where the doctor puts the camera into the colon through the anus to look inside the bowel. This is done under anesthesia.
What are the treatment options for anal fistula?
Anal fistula is most of the times treated with surgery. The surgery is done to treat fistula along with protecting sphincter muscles which could cause incontinence if damaged. Surgery for anal fistula is performed under general anesthesia. Laser surgery is the most advanced treatment. In this treatment, the laser energy user probe is inserted into the fistula canal destroying the fistula epithelium and also removing the tract. There are reasons it is preferred over other traditional methods for the following reasons:
- Minimally invasive procedure
- Quick recovery
- Resume normal activities within two days
- Short hospital stay
- No restrictions post-surgery
The traditional procedures include:
- Fistulotomy where there is no or little sphincter muscle involved. In this, the skin over the tunnel is cut to convert it into the open groove. This heals the fistulas from bottom up.
- Lift procedure where the skin on the fistulas are opened, the sphincter muscles are spread and fistula is tied off.
Recovery after the surgery
After the surgery, the surgeon may ask you to take sitz bath which is a warm water bath to soak in the affected area. The doctor may recommend you stool softeners or laxatives. The doctor may recommend you with pain killers after the surgery. What you have to do is follow the instructions given by the doctor for faster recovery. If you do this, fistulas will probably not come back. If you are willing to know more about the problem and laser surgery for anal fistula, consult a specialist at Pristyn Care.